Dissociative Disorders

Question 1

What are the 3 Dissociative Disorders groups?

Answer 1

1. Depersonalization/derealization disorder
2. Dissociative amnesia
3. Dissociative identity disorder

Question 2

What characterizes Depersonalization/Derealization Disorder?

Answer 2

An experience of detachment from the self and reality

Question 3

What characterizes Dissociative Amnesia?

Answer 3

A lack of conscious access to memory, typically of a stressful experience

Question 4

What characterizes Dissociative Identity Disorder?

Answer 4

At least two distinct personalities that act independently of each other.

Question 5

What is dissociation? What causes it?

Answer 5

Some aspect of emotion, memory, or experience being inaccessible consciously. According to psychodynamic and behavioral theorists, it’s an avoidance response that protects the person from consciously experiencing stressful events.

Question 6

What usually triggers Depersonalization/Derealization Disorders? And when does it usually begin?

Answer 6

DP and DR are usually triggered by stress, and usually begin during adolescence.

Question 7

What is comorbid with Depersonalization/Derealization Disorder?

Answer 7

1. Personality disorders

2. 90% experience anxiety disorders and depression

Question 8

What are the 4 DSM-5 criteria for Depersonalization/Derealization Disorder?

Answer 8

1. Depersonalization - Experiences of detachment from one’s mental processes or body, as though one is in a dream; or derealization - Experiences of unreality of surroundings
2. Symptoms are persistent or recurrent.
3. Reality testing remains intact.
4. Symptoms are not explained by substances, another dissociative disorder, another mental disorder, or by a medical condition.

Question 9

What 4 features of Dissociative Amnesia (main symptom, trigger, duration, and 1 distinct feature related to memory)?

Answer 9

1. An inability to recall important personal information, usually about a traumatic experience.
2. Usually occurs after severe stress.
3. Lasts between several hours and several years, and usually disappears as suddenly as it began, with complete memory recovery.
4. Procedural memory remains intact.

Question 10

What 4 other cause for memory loss should be ruled out in order to diagnose Dissociative Amnesia?

Answer 10

1. Substance abuse.
2. Brain injury.
3. Medication side effects.
4. Dementia.

Question 11

What are the causes for Dissociative Amnesia according to psychodynamic theory? And according to cognitive theory?

Answer 11

1. Psychodynamic theory - traumatic events are repressed.
2. Cognitive Theory - stress enhances encoding of central features of negative events, high levels of stress hormones and chronic stress interfere with memory formation.

Question 12

What characterizes the fugue subtype of Dissociative Amnesia?

Answer 12

Extensive memory loss, with an adoption of new identity. Memory recovery is usually complete except for the fugue phase.

Question 13

What are the 2 DSM-5 criteria for Dissociative Amnesia? What is the 1 DSM-5 criterion for Fugue subtype?

Answer 13

1. Inability to remember important autobiographical information, usually of a traumatic or stressful nature, that is too extensive to be ordinary forgetfulness.
2. The amnesia is not explained by substances, or by other medical or mental conditions.
3. Specify dissociative fugue subtype if amnesia is associated with bewildered or apparently purposeful wandering.

Question 14

What are the main features of Dissociative Identity Disorder?

Answer 14

A person has at least 2 separate personalities (=alters)- each has different modes of being, thinking, feeling, and acting, exists independently of one another and emerges at different times.
Primary alter may be unaware of existence of other alters and may have no memory of what other alters do, and usually seeks treatment.

Question 15

How many alters are usually diagnosed in Dissociative Identity Disorder?

Answer 15

2-4

Question 16

Is there a prevalence difference between genders in diagnoses of Dissociative Identity Disorder?

Answer 16

Yes, it’s more common in women.

Question 17

When is Dissociative Identity Disorder usually diagnosed?

Answer 17

In adulthood, but symptoms may date back to childhood.

Question 18

What is comorbid with Dissociative Identity Disorder?

Answer 18

1. PTSD
2. Major Depressive Disorder
3. Somatic Symptom Disorders
4. Personality Disorders

Question 19

What are some common (non-core) symptoms of Dissociative Identity Disorder?

Answer 19

Headaches, hallucinations, suicide attempts, self-injurious behaviors, amnesia, depersonalization.

Question 20

What are the 4 DSM-5 criteria of Dissociative Identity Disorder? + 1 criterion for children?

Answer 20

1. Disruption of identity characterized by two or more distinct personality states (alters) or an experience of possession. These disruptions lead to discontinuities in the sense of self or agency, as reflected in altered cognition, behavior, affect, perceptions, consciousness, memories, or sensory-motor functioning. This disruption may be observed by others or reported by the patient.
2. Recurrent gaps in memory for events or important personal information that are beyond ordinary forgetting.
3. Symptoms are not part of a broadly accepted cultural or religious practice.
4. Symptoms are not due to drugs or a medical condition.
5. In children, symptoms are not better explained by an imaginary playmate or by fantasy play.

Question 21

What are the estimated diagnosis rates of the 3 different Dissociative Disorders?

Answer 21

1. Depersonalization/Derealization: 2.5%
2. Dissociative Amnesia: 7.5%
3. Dissociative Identity disorder: 1-3%
   (These are likely overestimations)

Question 22

When are the first recordings of Dissociative Identity Disorders and Dissociative Amnesia from? And when did the diagnosis start increasing?

Answer 22

No identified reports of DID or dissociative amnesia before 1800s, increased rates since 1970s.

Question 23

How does the posttraumatic model explain the etiology of Dissociative Disorders?

Answer 23

As a way to cope with trauma, and also specifically with child abuse.

Question 24

According to the socicognitive model to the etiology of Dissociative Disorders, what triggers the appearance of dissociative symptoms?

Answer 24

The therapy, as well as exposure to media reports of Dissociative Disorders and other cultural influences.

Question 25

What are the 2 models for the etiology of Dissociative Disorders?

Answer 25

1. The Posttraumatic Model

2. The Sociocognitive Model

Question 26

“Dissociative Disorders could be iatrogenic” - what does this mean? And how so?

Answer 26

This means that it can created within treatment, as a response of the patient to suggestions made by the therapist.

Question 27

What are the evidences for the Sociocognitive Model of the etiology of Dissociative Disorders?

Answer 27

1. The symptoms can be role-played.
2. Some therapists reinforce DID symptoms (hypnosis, urging clients to remember, most clients are unaware of having alters before treatment, rapid increase in the number of alters as treatment progresses).
3. Alters share memories even when they report amnesia.

Question 28

What are the validated treatments for Dissociative Disorders?

Answer 28

Trick question!
There are no well-validated treatments available, no randomized controlled trails that have assessed psychological treatment, and medications have not been shown to relieve DID symptoms.

Question 29

How does the psychodynamic approach perceive Dissociative Disorders? What is the aim of the therapy?

Answer 29

DID is believed to arise from traumatic events that the person is trying to block from consciousness, so the goal of the therapy is to overcome repression.